Controversies on the treatment of irreducible elbow dislocations with an associated nonsalvageable radial head fracture.

Abstract

We report the case of a 26-year-old man who sustained an elbow dislocation with an associated radial head fracture entrapped in the joint, preventing closed reduction. A posterolateral approach to the radial head was performed to reduce the dislocation. A comminuted fracture of the entire radial head was found that required excision. Although radial head replacement has been stressed to restore sufficient stability in similar cases (because most are inherently unstable), it is important to determine whether the ulnar collateral ligament (UCL) is intact. Intraoperative use of valgus stress aids in that determination. The radial head can then be excised if the UCL is intact. In this case, no instability resulted with excision of the radial head because the UCL was intact. Failure to recognize and/or to treat an UCL rupture associated with radial head excision can result in elbow instability, increased elbow valgus deformity, and ulnohumeral arthritis.